what are the odds

So I just googled the title of what my friend calls my "secret blog." It's like keeping a journal, but easier cuz I can type it. And what pops up is a blog by the exact same name with even the EXACT same layout/background.

How unoriginal can I be??

Other than that, I just saw Reservoir Dogs for the first time in my life. I know--25 and never seen Reservoir Dogs. Well, at least I finally saw it. Brilliant film. One of the best films I've ever hated.

Now that's a good film.

we can relate

In other precious VA news, there was a day when I was walking through the hallways and a little old vet in a wheelchair I was passing by says to me, "Hey, may I see your hand?" And I said, "Sure, but why?" And he says, "Just let me see it." So I gave it to him and he kissed it. That just has to make you smile.

Then the nurses walked me through starting some IV catheters. The first guy I did it on I totally succeeded! He LOVED me. Maybe a little too much. He wanted me to hold his hand during his cataract surgery, but I told him I had other patients to attend to. Then he talked to me about 20 minutes afterward. I enjoyed that, but he hugged me twice and gave me a kiss on the cheek. He had a wife and all, but it almost didn't seem quite right. Almost. Like when you can't tell if someone's intentions are completely innocent, but because they're so old you only want to believe they are. It was fine until he said "When I get my next eye done, maybe you can lie next me during the surgery so I know it'll be ok." That sounded a little over the line. Yeah...sure thing... But he honestly was a sweet old guy.

For the most part the vets are awesome. Tough little old guys who'd have a lot of stories for me if I didn't have to run around after my team all the time. One man had ulcers all up and down his legs. He was so cute; somehow as we were changing his dressings the topic came to music. "I went to Woodstock you know." I said "Now THAT is amazing!" After music chat came alcohol chat. I'm holdin his leg up as my resident is winding an ACE bandage around it and the vet says, "You know what's really good is vodka and watermelon." "Yes sir, it is! Back in college we used to inject the watermelons with vodka!" "Mmmmmm!!!!"

You can't break the vodka-melon bond.

after my own heart

These next few posts are outdated, but I did want to write about them at the time. Things just got CRAZY.

So about a week and a half ago I was in Surgery with my Attending, who coincidentally reminds me of my Grandpa. This guy is a gruff old-school surgeon who inadvertently steals your heart, even though he calls you things like a "friggin dwarf." He has a characteristic swagger and love love LOVES to talk. So anyway, I was in surgery with my attending, holding a retractor as he was piecing through the intestines of a guy who needed a right hemicolectomy. He says to me, "Us surgeons are weirdos. I mean you have to be crazy to do what we do. We're weirdos and perverts. But without us, people would die." Well, at least some people would die. Surgery is really cool in that you have the potential to CURE a disease by taking the diseased portion of your body out. Like this guy's colon--and appendix, and Meckel's diverticulum, AND we fixed his inguinal and an umbilical hernia. Like my attending would say, "Bam! Boom! Yeah!"

So when he asked me last week, "What did you learn this month?" I said "That surgeons are perverts and weirdos." And he said "True." I also learned that taking two seconds to say "You did a really great job!" (be a patient cheerleader) or "I'm sorry we had to put you through that, but you'll be better now" is so appreciated that it should be standard. I also learned that you need to have all of your materials with you BEFORE you start changing a dressing, especially the special pink tape before the supply place closes.

And I learned that working on a team is just so rewarding that I can't wait to do it more!

Betadine blues

So this week in the VA news...

I need to place Foley catheters while on Surgery. I'm currently in a bind because I still need to place 2 more. They are urinary catheters, and it's easiest to do it to people when they're already anesthetized (for obvious reasons). So this week I finally placed my first one.

The scenerio is that good 'ol Marta had things set up for me. But then she AND Dino AND the scrub nurse AND my attending were all trying to tell me how to do it. They tell me to open up the dark orange betadine and quirt it into my sterile tray with all the cotton balls. "Go go go! Squirt it, squirt it!"

And suddenly they were treating it as something that needed to happen SUPER QUICKLY! So I get my sterile gloves on, and Dino says "now move your tray closer to the table so everything is in reach." But sterile gloves are sterile, and unsterile trays are not. SO I use my foot to pull the table closer...but it turns out the table is not a table..but...A LINEN CAN! Yes indeed folks, a linen can works JUST like a garbage can. So I stepped on the lever and FLIPPED THE ENTIRE TRAY. Betadine aaaaall over the floor. I immediately start laughing, as do many other staff members---Dino and Marta spring into action, getting me another Foley kit and situating me better. All I could do though was stand there in sheer embarassment and say to the scrub nurse, "It's OK if you want to laugh. I am." And she said "Hey, you gotta start somewhere."

The next part was a lot of "grab the penis---no GRAB IT! Pull it straight up. Make sure you're pulling it! Now push the catheter in...PUSH! PUSH IT! GO!" I wanted to be like "hey now...WHOOOOOA...let's all just take a deeeeep breath and take it down a notch."

In the end, it all got done. With extra jabs at me from my attending and interns the rest of the day. "You don't put betadine on the floor." Or one intern to the other, who hadn't witnessed the incident, "Hey J...you want to take a betadine bath?"

Sigh.

Blanchiest of 'em all

So not only did I get kicked out of a bar this weekend (what, you can't just be foolin around with a boy in this roped-off-do-not-enter area??), I also seem to work magic in the OR. Tonight I took call with a friend who is on Peds General Surg at Hershey; it was the only way I was going to see a real trauma, since the VA is deficient in that stuff during my regular working hours there. A girl came in from a bike accident that left her belly open---and her intestines out! It was a crazy one. I got to see it all start to finish, from the trauma bay to the OR to her waking up again. I doubt I'll be able to visit her (she isn't my patient), but I will keep tabs on her through that awesome friend of mine. So in the OR I was hangin out at the top of the bed with the anesthesiologists, one being a 4th year med student who decided to talk it up with me. We're joking around and havin a good ol surgical educational time (saying the wrong answers in front of the Attending, always super-fun!); and me standing there with my 2-sizes-too-big-borrowed scrubs and all, he says to me, "Well I'm only here for a month, and I'm so bored doing nothing on the weekends. Maybe you'd like to grab lunch with me?" "Sure!" "Ok, what's your number?"

That's right. Gettin' picked up in the OR. MIGHT I add that I don't even know what this guy looks like because, need I remind you, all are masked in the OR. He has nice eyes. His name might be Mark...or Matt....

On another note, I took out a guy's staples today. This guy is a crazy-man. He didn't even know I was doing it at first, and THEN whoa whoa whoa it was the biggest production ever; "Easy! Ow! Can you let me rest a minute? Let's take a rest a minute. Ow! Did you twist that one or somethin?!" Oi! Then Dino quizzed me on a bunch of anemia stuff I couldn't recall. Rough times. But good learnin times!

rock out with your...

So at 9:30 tonight, I was ready for bed. Whooo I was beat. But then I talked to my friend, and turns out 1st years (and 2nd years and 3rd years and grad students) were hittin up the local bar. Things that came to pass:
1. We started the dance party. Oh yes.
2. I saw a former potential love interest, an attempted set-up by a friend, who'd scorned me---and I paid him back with a sweet dance-off. All in good fun and water under the bridge. Think he'll call?
3. We waited a half an hour for 2 measly shots of Jager. Go figure.
4. The boy I got my groove on with a few weeks ago? Reportedly not the sweetest banana of the bunch. C'est la vie.
5. A friend stepped on my baby toe and squooshed it to some bits. And I kept dancing on it though I knew it was a bloody mess. Thank goodness for all that VA training in wound healing and wound care.
6. Now it's WAY past my bedtime!

As for BK's Railroad moves and Rotator Cuff jive, and KR's hemiballismus poses, HOLLA! So inappropriate. Yet so much fun.

Gonna feel it in the mornin,
;)

comin up crazy

Today I saw a man in extreme pain as we changed his dressing. He was bitten by a brown recluse spider (yes, just like Jacques Demboise), and that ate away at the skin on the front part of his leg to create a one foot by half-a-foot giant fleshwound. (Google Image a "brown recluse"---stupid Blogger won't let me upload a picture OR a link to a picture.) The poor guy, we drugged him up so that he wouldn't be in such pain; you have to pull the old dressing off, and since it's a vacuum-sponge, it's stuck tight to the wound. Then you need to cut the new sponge to fit the wound, place it on, tape a sterile clear sticky pad on top of it...and then stand back cuz once you turn on the vacuum he will want to jump out of the bed and scream in pain. So this guy gets a dose of narcotics, and it didn't take. So one of my interns gives a half-dose more, and the guy's eyes are just rollin back in his head and he lays back. The intern kept saying "Are you still with us? Big deep breaths Mr. A! Good, you're doing well." At one point though he shot straight up in pain and then laid back down hyperventilating and crying. He won't remember it, but it was just so awful and scary, and I felt so badly for him. Plus we had to monitor him extra closely what with the CNS and respiratory depression the narcotic gave him. This will have to happen like every 3rd day...

Then I went to the bathroom, my glasses fell off my face, and I fractured my left lens!!!! NO!!!!!! These glasses are so frickin new, my script is soooo frickin bad, and they cost too frickin much (although Lenscrafters originally screwed my order up so bad, I'd ended up getting them for like 45% off).

Then I took out a super-nice middle age man's sutures at clinic. I had no idea that it was just cut and pull; the guy didn't even feel it! Is it weird to say that it was really fun?

So Lenscrafters says to me, "We have to replace BOTH lenses due to optical error. We'll give it to you half price, though; it'll be $190."

!!!!!

After work/classes, I went to the store for mozarella whilst Gen cooked up part of the Eggplant Parm. I came to the realization that I come to on a daily basis, which is that I like boys a lot. I like how they're built. I thought this as a checked out a hot boy at the store.

After Gen and I feasted, I dragged myself over to Lenscrafters where I got the damage report: "It looks like they broke from the frame. Since you've only had these for a few months, I'm going to give the lenses to you free of charge."

FREE OF CHARGE! That's the best thing I've heard ALL DAY!

And how was your day

PAR-TY!

Will there ever come a Friday night on which I do not want to go out with friends?! God I hope not. It happens eeeevery week. Friday rolls around and I start making phone calls and dropping texts like a madwoman. Even last Friday, after my first 73-hour work week; my buddy Ingles (I wish I could add an accento to that e cuz that's how it's supposed to read---inGLES, en Espanol...dammit, no tilde for the enyay) and I were for all intents and purposes practically post-call. I'd had three 3-hour naps over the last 48 hours, and who knows what he'd had. But, we sucked it up, we chugged some tea, and we fucking BROUGHT it. We rocked the Hizzle (that's Harrisburg) til the Quarter closed. Up for 24 hours! WOOT! And then we went back and did it again the NEXT night! Champions!!!

It might explain why I slept through my alarm on Tuesday...

And yet, you know what day it is today! Let's party!!!!!! My only huge wish: to get all the residents I've worked with over the past 5 weeks out to the same bar I'm going to. THAT would be hilarious and magical! MAN.

you did what to who?!

So we have a patient who has been in the hospital for a long time. Every time I think I get a chance to go look at his full record and figure out what he has, I'm pulled in another direction. Tomorrow is a Friday, so after I'm free to go I'm going to take some time and figure out how on earth he got into the predicament he is in now.

See, Mr. H has an open wound. We're talking HUGE open. It's a midline incision of basically his entire abdomen. I think he'd had surgery for colon cancer, and then the wound dehisced---it dried out and fell apart instead of healed. So he's been laying down with this packed open wound for like a month. All his intestines are just sitting out and about. They've irrigated and drained it multiple times. Now the body has a reactive process in which it covers things like this up with fibrous tissue---the same stuff that makes a scar. So when I saw Mr. H's open wound finally in the O.R. today, it's not like guts hanging out---it was more like a pink bag sticking out of his abdomen. Granulation tissue has covered up the guts part. And here it is.

So wounds close if you have the sides of the wound pulled together---but Mr. H's body/skin is waaaaay far apart on both sides of pink guts bag. So what they did today is take pieces of tissue called Alloderm and sew it together and then covered up the wound with it. Alloderm---it is the dermis, or innermost part of the skin,...from a cadaver! Just strips of this stuff. You like stick it in water for a half an hour til it's soft. Then you sew it up piecemeal making it fit like a puzzle. And I helped sew it on.

So my senior resident, whom I adore by the way, I must reveal his name cuz it's so characteristic: Dino. Yep, Dino. He's originally from NYC. Dino says to me mid-stitching, "Now Katie, if you mess this up, YOU are presenting the case at M & M." M & M is a mnemonic that I cannot remember (something and Mortality maybe? Morbidity and?) for a weekly conference that all medical teams have. You talk about patient management that went wrong, where and how it went wrong, and what to do to not screw it up the next time and what-not. A lot of ethics. You also present deaths at the conference. So thanks a lot Dino, while I'm throwing stitches for like the 5th time EVER on this cadaver skin to cover up this guy's abdomen, tell me once again that if it doesn't work it's my fault! He was kidding of course...

The Alloderm is Mr. H's last shot at getting his wound closed. My attending kept saying he was both a charlatan and a shaman for attempting this deal. It's also super-expensive stuff, so much so that the head O.R. nurse came storming in and told off my attending, saying "They're not going to give you that much money! You just spent my entire Surgery budget!" It was quite dramatic.

At the end of the day today, we were consulted for a man with primary breast cancer. Yep. This is another thing for me to look up tonight. It turns out that his primary care physician had found his breast lump like over a year ago---and now the guy comes in with shortness of breath. He has metastases all over his body, including his lungs, which has caused fluid to leak into his lung sacs (pleural effusions), squishing his lungs so he can't breathe well. Basically he was untreated, or rather treated only with Vitamin E (to which my attending yelled some expletives), and now he will die much sooner because of it. It's a terrible mess, and we're going to see how best to fix it starting tomorrow.

Just another day at the good 'ol VA.

nightmare!

So! I've just started my General Surgery rotation at the VA hospital in Lebanon. It is about 30 minutes away---Monday was an orientation, Tuesday I saw a BUNCH of colonoscopies and met my resident Dino (the interns were being oriented that day, so it was just Dino and me); and TODAY...

So I was supposed to report today at 6:30 AM. No big deal, actually get to get up at 5:00, an hour later than my Neurosurgery times! Woot! So I went to bed last night at 10 PM.

This morning I awake from what must've been a pleasant dream because I felt really good when I woke up. This changed instantly when I noticed that it was LIGHT out. Immediately I looked for my alarm clock---which was IN THE BED WITH ME. I 1. had ZERO recollection of turning it off and yet 2. deduced that it must've went off, I must've pulled it into bed in usual fashion and hit the snooze, and yet somehow TURNED IT OFF!!! So now it is 8:15 AM and all I can do is cry and call Linda, the southern woman with a stutter that is our wonderful resident/med student coordinator at the VA. "Nah don't come a-rushin over heah and get ya-self in an accident. You just take yah tiiime. Yah body musta needed it is awl!"

I still cried about 8 times in my 30-minute drive over. I found Dino furiously tryin to navigate an old guy's tortuous sigmoid colon; when he was done, he just came over to me smiling and told me not to worry about it. But seriously, how f-in irresponsible can I look showing up 2 and a half hours LATE! Thank God there wasn't a patient's life on the line!

Lessons learned: 2 alarm clocks. One set faaaar away. And get some frickin sleep.